COVID-19 Risk and Atopic Dermatitis

A new study published in the Journal of the American Academy of Dermatology International aimed to better understand the association between COVID-19 infection and atopic dermatitis.¹ The researchers performed a case-control cohort study using the All of Us cohort, including 11,752 adult patients with atopic dermatitis and 47,008 matched controls.

Results of a multivariate analysis showed that patients with atopic dermatitis had a higher risk of COVID-19 infection than healthy controls. Patients with atopic dermatitis were also more likely to have a higher mean body mass index and to have hypertension, hyperlipidemia, type 2 diabetes, sleep apnea, cardiovascular disease, malignancy, and autoimmune disease.

To find out more about the study and its results, The Dermatologist reached out to lead author Jeffrey M. Cohen, MD, who is a board-certified medical dermatologist and the director of the Interdisciplinary Psoriasis Treatment Program at the Yale School of Medicine in Branford, CT.

Can you tell us more about your study, and how your findings are significant?
In our study, we used the All of Us database, which is a database that’s provided by the National Institutes of Health. It has been enrolling participants since 2018 and continues to actively enroll participants.

It is a powerful database that gives us a lot of information about a lot of people in the United States, and this information is continuously being updated and entered into the system. Using this database, we were able to identify 11,752 patients who had atopic dermatitis, and then more than 47,000 controls to use as comparators.

Among these individuals, we found that 4.2% of people with atopic dermatitis, compared with 2.8% of participants in the control group who did not have atopic dermatitis, got COVID-19. These are people who were very similar in terms of their racial/ethnic background, their gender, their age, and so these were good people to compare.

Then, we created statistical models to try to understand what the true risk of COVID-19 is with atopic dermatitis. When we did this, we found that there was a 30% increase in the odds that someone would get COVID-19 if they had atopic dermatitis. We did this controlling for variables that we know are very important for COVID-19—factors like body mass index, hypertension, diabetes, and other comorbidities that we have heard over the course of the pandemic that increase the risk for COVID-19.

Even when we controlled for those factors and tried to isolate atopic dermatitis, we still found that the odds were increased by 30% that someone would get COVID-19. It is important to understand that this, in absolute terms, is not that great of a risk. We only found that 4.2% of people with atopic dermatitis got COVID-19, compared with 2.8% without AD.

While that is a statistically significant and important difference, we also want to make note that this absolute change is not that much, and it was still fairly uncommon for people with atopic dermatitis to be diagnosed with COVID-19.

Similarly, while a 30% increase in the odds sounds like a lot, you have to also put that in the setting of what the absolute difference is in the risk. This is important, but we want to make sure that people understand that atopic dermatitis represents another risk factor for COVID-19 infection.

How can dermatologists identify patients with atopic dermatitis who are at higher risk for COVID-19?
Of course, people with atopic dermatitis are not getting COVID-19 all the time, but they do get it slightly more often. Atopic dermatitis is certainly a risk factor for COVID-19, like other risk factors that we have discussed, such as obesity, diabetes, and so forth. Dermatologists should know this, because they can talk to patients with atopic dermatitis to make sure that they are aware that atopic dermatitis contributes to their risk for COVID-19.

If your patients have comorbidities plus atopic dermatitis, it might open the door for a conversation about the risks associated with atopic dermatitis and COVID-19, COVID-19 vaccination, and counseling for managing their comorbidities.

What future research is needed to better understand the association between atopic dermatitis and COVID-19?
The main factor we need to understand is the mechanism of action. All of these epidemiologic studies are good at showing us what associations exist, but they only show us correlations between things and not the causes of the phenomena that we observe.

Something that would be very interesting, particularly in light of some of the information that we have about dupilumab and COVID-19 risk, would be to understand whether there are underlying immunological factors for patients with atopic dermatitis that may increase their risk for COVID-19. For example, investigating levels of IL-4 and IL-13—which are the Th2 cytokines that are the central cytokines for atopic dermatitis—as our current treatment, dupilumab, and others that are coming through the pipeline, including one that was just FDA approved, targets these cytokines.

Trying to understand how these cytokines impact COVID-19 risk is important. Some data suggest that the levels of these cytokines is associated with COVID-19 infection and severity of infection, but more studies focusing on the atopic dermatitis population may be very informative for helping us understand the link between atopic dermatitis and COVID-19.

What other pearls would you like to share regarding atopic dermatitis and COVID-19?
Because our study suggests that atopic dermatitis is a risk factor for COVID-19 infection, it gives us the ability to talk to our patients with atopic dermatitis about things they can do to help prevent getting COVID-19.

These are important things that we have been hearing representatives of the Centers for Disease Control and Prevention talk about over the entire pandemic. Things like wearing masks, avoiding contact with those who we know have COVID-19, and getting vaccinated. These become important factors that can help mitigate some of the risks that people have, whether that risk is obesity, diabetes, or atopic dermatitis.

1. Fan R, Leasure AC, Damsky W, Cohen JM. Association between atopic dermatitis and COVID-19 infection: A case-control study in the All of Us research program. JAAD Int. 2022;6:77-81. doi:10.1016/j.jdin.2021.12.007